Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 189437 | NY |
N | 111NI0900X | Internist | 189437 | NY |
Y | 207RG0300X | Geriatric Medicine | 189437 | NY |
NPI | 1114941887 |
---|---|
Provider Name | Tita D. Castor |
First Address | Elmhurst, NY 11373-1329 |
Second Address | Elmhurst, NY 11373-1329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 10/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01678651 | (05) | NY |
F41816 | (02) | NY |